WCLC 2018 — Advanced NSCLC: immuno-oncology less commonly used than expected

  • Brian Hoyle
  • Univadis
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  • A retrospective analysis of 2700 patients with advanced NSCLC treated with first-line chemotherapy has revealed lower-than-expected use of immuno-oncology second-line therapy.

Why this matters

  • NSCLC remains a catastrophic disease.
  • Chemotherapy has been the dominant first-line treatment.
  • NSCLC that fails such first-line therapy has a poor outcome.
  • Approvals of immuno-oncology drugs since 2015 have made them a viable second-line treatment option.
  • The prevalence of immuno-oncology drugs as second-line treatment is unclear.
  • Knowledge of current second-line treatment decisions could help guide future treatment.

Study design

  • Retrospective analysis of adult patients in the United States treated for lung cancer using first-line chemotherapy between March 2105 and December 2016.
  • NSCLC treatment as recommended by National Comprehensive Cancer Network including temozolomide, topotecan, and prophylactic cranial irradiation
  • Patients also received second-line treatment within 1 month of first-line treatment
  • Funding: Bristol-Myers Squibb.

Key results

  • 2700 received first-line chemotherapy, 829 with recorded second-line systemic therapy.
  • Of the 829: second-line chemotherapy for 539 (65%), second-line immuno-oncology for 262 (32%), second-line targeted therapy for 28 (3%).
  • Use of immuno-oncology therapy lower than anticipated.
  • Factors increasing likelihood of immuno-oncology therapy: commercial insurance (P<.0001 chronic obstructive pulmonary disease at diagnosis longer time to discontinuation of first-line therapy>
  • Factors decreasing likelihood of immuno-oncology therapy: secondary malignancy at diagnosis (P=.001), diabetes with chronic complications at diagnosis (P=.031), first-line combination therapy (P<.001>
  • COPD associated with use of immune-oncology was surprising, as it can increase the risk for pneumonitis.


  • No histology or staging information available, so inclusion of patients with SCLC was possible.
  • Patients receiving maintenance therapy may have been classified as receiving second-line therapy, and vice versa.
  • Unable to account for clustering of patients within institutions or treated by same provider.

Expert comment

  • "The initial, perhaps irrational, exuberance over immuno-oncology therapy did not result in its widespread adoption at the time of this study. The results beg the question of what drives treatment decisions," said presenter Bruce Feinberg, DO, Cardinal Health, Dublin, Ohio.